Information Collection

Organization Climate and Safety Conscious Work Environment

IC 185026 under ICR 200805-1910-003 · OMB 1910-5138.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Survey - Attachment 3 (Survey).doc	Other-Survey

IC Title:

Agency IC Tracking Number:

Mark VanDerPuy

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 10 CFR 63.9

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			Survey - Attachment 3 (Survey).doc		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,750

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	1,750	1,750
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.